Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Thirty-one patients about to undergo surgery for gastroesophageal reflux were randomized into either a Nissen fundoplication group (12) or a modified Toupet semifundoplication group (19). All patients were followed on a long-term basis for 5 years with a standard questionnaire, endoscopy, and manometry. Ninety-five percent of the patients in the modified Toupet group had good or excellent results versus 67% for the Nissen group. However both procedures are effective in curtailing esophagitis with an improvement of the endoscopic grading in the Nissen group by 91% and 89% in the group undergoing the modified Toupet procedure. A significant improvement in symptoms (acid regurgitation, heartburn, retrosternal pain) was noted in both groups, except for dysphagia in the Nissen group. Three patients with a Nissen fundoplication had a slipped Nissen requiring reoperation and two had gas-bloat syndrome. These specific complications of the Nissen procedure were not found in the modified Toupet group.
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PMID:A long-term randomized prospective trial of the Nissen procedure versus a modified Toupet technique. 268 67

The study presents results from a five-year follow-up on abdominal symptoms in an age and sex stratified random sample of 4,581 Danes. Abdominal pain occurred significantly more often among women (prevalence: 49%, incidence: 21%) compared to mean (prevalence: 38%, incidence: 15%). Five years later the pain had disappeared in 43% of the men and 31% of the women (p = 0.003). Distension, borborygmi, and altering consistency of stools occurred with a prevalence of approximately 50% and an incidence of approximately 30%, significantly more often among women compared to men. Five years later these symptoms had disappeared in about 20%. Prevalence of both heartburn and acid regurgitation were significantly higher among men (38%) than women (30%), whereas no sex difference was observed regarding incidence of these symptoms (16%). Approximately 30% of subjects who had experienced heartburn or acid regurgitation did not do so five years later. In conclusion, abdominal symptoms occur frequently and recurrently in the general population. This information is of importance to doctors when they evaluate patients with abdominal complaints, but no obvious organic etiology.
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PMID:Epidemiology of abdominal symptoms in a random population: prevalence, incidence, and natural history. 785 55

The aim of the study was to assess the association of abdominal symptoms in a random sample of a general population and to find whether the associations could be confirmed at follow-up 5 years later. The study population was a sex- and age-stratified random sample of people living in the western part of Copenhagen County, Denmark. Of 4807 eligible subjects 79% attended the study and filled in a questionnaire on abdominal symptoms. Five years later the study was repeated and 85% of the survivors participated. Data from both studies were analysed separately for sex, age group and the following pain variables: unspecified abdominal pain, pain located to the epigastrium, pain provoked by stress or hunger, pain relieved by eating and pain relieved by defecation. Three clusters of symptoms occurred in all the analyses: borborygmi/altering stool consistency/distension; acid regurgitation/heartburn and nausea/vomiting. Unspecified pain was associated with all three clusters, pain provoked by stress or hunger and pain relieved by defecation associated with the borborygmi/altering stool/distension cluster, whereas pain in the epigastrium and pain relieved by eating did not show consistent relationships to any of the clusters. Additionally, the clusters associated with each other more often than could be expected by chance. As a consequence of our findings we suggest that the three clusters of symptoms constitute three common abdominal syndromes.
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PMID:Abdominal symptom associations in a longitudinal study. 814 91

Forty patients with gastro-oesophageal reflux disease and oesophagitis, documented by endoscopy (grades I to III by the Savary-Miller classification) were randomized to participate in a comparative double-blind trial to receive cisapride (10 mg q.d.s.) or ranitidine (150 mg b.d.) for an 8-week period. Upper gastrointestinal endoscopy was performed immediately before the entry to the trial and after the 8-week period at the completion of the trial. The evaluable cohort included 37 patients who completed the trial, 18 in the cisapride group and 19 in the ranitidine group. Three patients were withdrawn from the trial; one on ranitidine developed severe anaphylactic reaction, one on cisapride severe dizziness and one on cisapride did not wish to continue on the trial. The results of the trial, regarding symptomatic and endoscopic improvement were comparable in the two groups. Both drugs were effective in controlling symptoms, such as acid regurgitation, retrosternal pain, retrosternal burning, epigastric fullness and discomfort (pain, burning, sense of pressure) and resulted in endoscopic healing of oesophagitis. With few exceptions, symptoms remained in remission 1 month after treatment in the majority of patients. Globally, both drugs were tolerated comparably, and adverse effects other than those which resulted in the withdrawal from the trial were minimal in both groups. The results of this trial indicate that cisapride and ranitidine, although of different pharmacological action, are comparable in their therapeutic effect in symptomatic improvement and endoscopic healing in patients with mild to moderate gastro-oesophageal reflux disease.
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PMID:Cisapride and ranitidine in the treatment of gastro-oesophageal reflux disease--a comparative randomized double-blind trial. 816 70

With the aim to assess the clustering of abdominal symptoms in a random population, data from a cohort study of a 70 year old Danish population were analysed. The cohort comprised 1,119 subjects of which 72% participated in a primary study and 91% of the survivors in a similar study five years later. The following clusters of symptoms were constantly associated. One group constituted abdominal distension, borborygmi, altering stool consistency and number of bowel movements. Pain relieved by bowel movement was associated with this cluster. Nausea and vomiting comprised another cluster. Heartburn/acid regurgitation did not show a consistent association to any other symptoms and may be considered as a cluster of it own. Pain characteristics traditionally related to upper dyspepsia did not specifically relate to any cluster. It is concluded that, in this 70-year-old population abdominal symptoms occur in clusters comparable to clusters in younger populations. The clusters, however, does not totally confirm the traditional concept of Upper Dyspepsia and Irritable Bowel Syndrome.
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PMID:Irritable bowel syndrome and upper dyspepsia among the elderly: a study of symptom clusters in a random 70 year old population. 881

Pantoprazole is an irreversible proton pump inhibitor which, at the therapeutic dose of 40mg, effectively reduces gastric acid secretion. In controlled clinical trials, pantoprazole (40mg once daily) has proved superior to ranitidine (300mg once daily or 150mg twice daily) and equivalent to omeprazole (20mg once daily) in the short term (< or = 8 weeks) treatment of acute peptic ulcer and reflux oesophagitis. Gastric and duodenal ulcer healing proceeded significantly faster with pantoprazole than with ranitidine, and at similar rates with pantoprazole and omeprazole. The time course of gastric ulcer pain relief was similar with pantoprazole, ranitidine and omeprazole, whereas duodenal ulcer pain was alleviated more rapidly with pantoprazole than ranitidine. Pantoprazole (40mg once daily) showed superior efficacy to famotidine (40mg once daily) in ulcer healing and pain relief after 2 weeks in patients with duodenal ulcer in a large multicentre nonblinded study. In mild to moderate acute reflux oesophagitis, significantly greater healing was obtained with pantoprazole than with ranitidine and famotidine, whereas similar healing rates were seen with pantoprazole and omeprazole. Pantoprazole showed a significant advantage over ranitidine in relieving symptoms of heartburn and acid regurgitation. Reflux symptoms were similarly alleviated by pantoprazole and omeprazole. Preliminary results indicate that triple therapy with pantoprazole, clarithromycin and either metronidazole or tinidazole is effective in the treatment of Helicobacter pylori-associated disease; however, these findings require confirmation in large well-controlled studies. Pantoprazole appears to be well tolerated during short term oral administration, with diarrhoea (1.5%), headache (1.3%), dizziness (0.7%), pruritus (0.5%) and skin rash (0.4%) representing the most frequent adverse events. The drug has lower affinity than omeprazole or lansoprazole for hepatic cytochrome P450 and shows no clinically relevant pharmacokinetic or pharmacodynamic interactions at therapeutic doses with a wide range of drug substrates for this isoenzyme system. In conclusion, pantoprazole is superior to ranitidine and as effective as omeprazole in the short term treatment of peptic ulcer and reflux oesophagitis, has shown efficacy when combined with antibacterial agents in H. pylori eradication, is apparently well tolerated and offers the potential advantage of minimal risk of drug interaction.
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PMID:Pantoprazole. A review of its pharmacological properties and therapeutic use in acid-related disorders. 888 82

The HT4-agonist Cisapride (CIS) and the peripheral D2-antagonist Domperidone (DOMP) have distinct prokinetic actions. We compared their clinical efficacy in 127 dyspeptic patients. Patients with upper abdominal complaints of > 1 month duration, who had a normal UGE were allocated to the REFLUX-group (RG), (predominance of heartburn, acid regurgitation or retrosternal pain) or if devoid of this specific symptomatology to the DYSPEPSIA-group (DG) In a double-blind randomised fashion and allocated to 10 mg CIS or 20 mg DOMP qid (RG) or tid (DG) for 1 month and followed-up for further 2 months. In RG (N = 43, p < 0.05) the response rates were clearly in favour of CIS, but not in DG (N = 84). In RG DOMP was more effective against nausea. The benefit of both therapies was largely maintained in the follow-up period. Cisapride and domperidone were effective in the treatment of dyspepsia. Cisapride was more effective than domperidone in the REFLUX-Group.
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PMID:Study with two prokinetics in functional dyspepsia and GORD: domperidone vs. cisapride. 922 23

Although most patients with gastroesophageal reflux disease (GERD) present with the classic symptoms of heartburn and acid regurgitation, many complain of atypical chest pain suggestive of cardiac disease. Once cardiac ischemia has been excluded, it is important to consider GERD because this may be established as the cause of pain in 10% to 50% of such patients. If GERD is suspected or documented, vigorous antireflux treatment, preferably with proton pump inhibitory therapy, is indicated.
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PMID:Management of complicated gastroesophageal reflux disease: atypical chest pain. 934 86

The meaning and definition of dyspepsia continues to challenge clinical investigators and has led to the setting up of several international working teams. However, confusion continues to reign around this term. The effort to classify patients with dyspepsia into subgroups according to their most predominant symptoms has failed to provide clues to the underlying disease, or even to discriminate between functional and organic dyspepsia. With these limitations in mind, the question arises: is there any reason for putting further effort into developing a world-wide definition of dyspepsia when, in addition to the aforementioned shortcomings, further variables such as geographical region, ethnic background, culture and sanitary resources come into play? The answer is that only by establishing a reproducible methodology for individual symptom assessment using a well-defined protocol will comparisons of the prevalence of dyspepsia and the impact of different therapeutic interventions become possible around the world. The data on dyspepsia prevalence, nearly all arising from studies in a few developed geographical areas and countries, are of the order of 1-4% of all consultations in all primary care medicine. However, estimates of adults affected by dyspepsia are as high as 20-40%. The magnitude of these statistics underlines the necessity for further work on the concept of dyspepsia and its major functional subgroups, following the exclusion of any organic causes. Issues such as 'investigate dyspepsia before starting with any kind of treatment or treat dyspepsia before further investigation' or the debate about whether to 'eradicate or ignore Helicobacter pylori in functional dyspepsia' will remain unresolved unless studies performed throughout the world use widely comparable and acceptable definitions and criteria for these conditions. Since the first international working party report in 1988, definitions of dyspepsia have included the description of 'upper abdominal pain or discomfort' and, more recently, have specified 'pain or discomfort centered in the upper abdomen' in order to emphasise further the site of origin as the upper alimentary tract (stomach-duodenum). However, a major change was evident in the more recent Rome I and Rome II reports, in which the symptoms heartburn, acid regurgitation, and belching were excluded from the definition of dyspepsia because of their relation to gastroesophageal reflux disease (GERD) and aerophagia. The intention to define a set of symptoms for dyspepsia is good, but we continue to be faced with overlaps. How should the patient with epigastric pain and heartburn after endoscopic exclusion of duodenal ulcer and reflux esophagitis be classified: dyspepsia or GERD? In cases of abnormal gastroesophageal reflux, 24-h pH monitoring could help to resolve this dilemma, but what if this investigation turns out to be normal? In this field, we need to perform careful studies. In addition, we need to consider the lifestyle and cultural habits of people around the world when translating upper gastrointestinal symptoms into dyspepsia. A step forward in the definition of dyspepsia was attempted by the recent working party for the Rome II consensus on functional gastrointestinal disorders (N. Talley et al.). In this project, the symptoms of dyspepsia were individually described not by a single term, but by painting a 'word picture', to make it easier for patients to express their symptoms, and give doctors and clinical investigators a better understanding of the 'dyspeptic problem' of each individual. It is advisable to follow this approach, since a clear picture of a patient's symptoms, including their duration and intensity, in association with the modern technical approaches that allow investigation beyond organic causes of dyspepsia, will lead to progress in our understanding and better communication about this problem within the medical community, and ultimately to better treatment.
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PMID:Current concepts in dyspepsia: a world perspective. 1044 9

Dyspepsia is defined as chronic or recurrent pain or discomfort centred in the upper abdomen. Early satiety, nausea, vomiting, or bloating are often also present. Dyspepsia should be differentiated from gastro-oesophageal reflux disease, whose predominant symptoms are heartburn and acid regurgitation. Prevalence rates vary between 25% and 40%, and dyspepsia is the main reason for consulting GPs: 3-5% of all visits. Older patients and patients presenting with alarm symptoms (weight loss, anaemia, jaundice, dysphagia, bleeding) should undergo endoscopy, but apart from this no other management strategy has been agreed upon. Management strategies based on non-invasive H. pylori testing will probably prove cost-effective and safe. However, the results of clinical trials are awaited before guidelines can be offered. The symptomatic effects of treating patients with functional dyspepsia with either acid inhibitors, prokinetics, or H. pylori eradication therapy are difficult to predict and are usually quite modest.
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PMID:[Dyspepsia. Investigation and treatment]. 1157 69


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